Individual
JAMIE SPARKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1000 ILLINI DR, O FALLON, IL 62269-3571
(618) 622-9246
Mailing address
1000 ILLINI DR, O FALLON, IL 62269-3571
(618) 622-9246
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
07/30/2009
Last updated
07/30/2009
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